Fingertip injuries can occur in accidents at home, work, or play. An injury can involve
a sharp cut, a crushing injury, a tearing injury, or a combination of these injury
types. An amputation can result from slamming your finger in a car door or catching
your ring on a hook or nail.

An injury or amputation can damage any part of the fingertip, including the:

Skin and soft tissue

Fingertip bone (distal phalanx)

Nail and underlying nailbed

The tips of longer fingers tend to be injured more often because they are last to
escape from harm's way.

Your fingertips are rich with nerves and are extremely sensitive. Without prompt and
proper treatment, a fingertip injury can cause problems with hand function, and may
even result in permanent deformity or disability. To ensure the best outcome, it is
important to have your doctor examine your finger or thumb after an injury.

An injury or amputation can involve any of the structures in the fingertip.

Medical History

Your doctor will talk with you about your medical history and the circumstances of
your injury. He or she will want to know if you have any medical conditions, such
as diabetes, if you smoke, or if you take any medications. Your doctor will also want
to know if you have experienced a previous injury to the affected hand.

To help plan your treatment, your doctor will ask several questions. These may include:

How and when did your injury occur?

Is the injured finger on your dominant hand?

What do you do for a living?

What are your recreational activities?

Do you smoke or use tobacco products?

Have you ever had hand problems caused by osteoarthritis, diabetes, rheumatoid arthritis,
or any other medical condition?

Is your tetanus immunization up-to-date?

Physical Examination and Immediate Care

Your doctor may give you a numbing injection (digital block anesthesia) to help reduce
the pain in your injured finger. He or she will irrigate, or wash out, your wound
with a saline solution to see it more clearly and to reduce the risk of infection.

Your doctor will examine your finger carefully, looking for:

Exposed bone

Missing tissue

Injury to the nail and nailbed

Your doctor will then thoroughly clean out the wound, removing dead tissue and contaminants.
This procedure is called "debridement." This will reduce your risk for infection.

If your doctor suspects that you have broken bones, he or she may order x-rays. Some
fingertip injuries can cause bleeding under the fingernail—a condition called "subungual
hematoma." If this is the case with your injury, your doctor may pierce your fingernail
to relieve the pressure. He or she may also remove your fingernail if the nailbed
underneath requires repair.

Your doctor may prescribe an antibiotic and/or give you a tetanus shot to prevent
infection.

The goal of treatment is to have a pain-free fingertip that is covered by healthy
skin and functions normally. Your doctor will try to preserve the length and appearance
of your finger.

Treatment for a fingertip injury or amputation depends on the angle of the cut and
the extent of the injury. To determine the best treatment for your injury, your doctor
will consider your general health and lifestyle, as well as your preferences.

(Left) Wounds made along the green lines will probably heal on their own. (Right) Wounds made along blue lines will probably need some sort of surgery to heal.

Injury Without Exposed Bone

Minor tissue injury. If your fingertip wound is small and not deep enough to expose bone, it may heal
on its own. Your doctor may place a protective dressing over the wound with instructions
to change the bandage regularly. He or she may recommend that you wear a splint to
protect the area while it heals.

After about 24 to 48 hours, your doctor may recommend that you soak your finger daily
in a solution of warm, soapy water or saline solution with peroxide or betadine. After
48 hours, range-of-motion finger exercises may be started to avoid stiffness.

Complete healing usually takes from 2 to 4 weeks, although stiffness and hypersensitivity
may remain longer, depending on the severity of the injury.

Larger tissue injury. If your fingertip wound is large and open, there may not be enough remaining skin
to heal and cover the open area.

In some cases, the wound may be left open to heal gradually on its own. This is called
healing by secondary intention.

Sometimes, surgery may be required to ensure healing. Surgical procedures used to
treat larger tissue injuries may include:

Skin grafting. In this procedure, a piece of skin (skin graft) is taken from the outside of your
hand, your forearm, or another site and used to cover the injury. Both the wound and
the donor site are closed with stitches during the procedure.

Reconstructive flap surgery. Because a skin graft does not have its own blood supply, it may not be sufficient
for some larger tissue injuries. If this is the case, your doctor may take a full-thickness
flap of skin from a healthy part of your injured hand and use it to cover your wound.
This procedure is discussed in greater detail in the section below.

Exposed Bone Injury

For injuries that expose the bone, there may not be enough tissue around the wound
to stitch the wound closed. Sometimes, the bone needs to be shortened so that your
wound can be stitched closed. Shortening the bone slightly usually does not hurt your
ability to use your hand.

In some reconstructive flap surgeries, the flap remains attached to the donor site
during healing.

Reconstructive flap surgery. It may be necessary to cover the wound with new skin, as well as the fat and blood
vessels underneath the skin. This is called "reconstructive flap surgery."

The flap of skin and soft tissue is taken from a healthy part of the same hand. Common
donor areas are the injured finger itself, a non-injured finger, and the palm of the
hand. A skin graft may be used to cover the donor area and to help it heal.

In some cases, the flap is not fully removed from the donor area. The flap is sewn
over the wound but it remains connected to the donor area. This is done to ensure
a healthy blood supply to the flap as it heals over the wound.

Your doctor will apply a bulky dressing to protect the area while it heals. He or
she may also apply a splint to help support your hand. Your uninjured fingers will
be left free to exercise.

It typically takes a few weeks for the flap to heal over the wound and establish a
blood supply from its new location. When this occurs, the flap will be detached from
the donor area.

Replantation. If your injury has cut off a large part of your fingertip, your surgeon may consider
the pros and cons of reattaching the amputated part. This is called "replantation."
This is a complicated surgical procedure during which blood vessels are repaired to
allow both the inflow and outflow of blood to the amputated part. A replantation can
require significant recovery time for the patient.

Fingertip Amputations in Young Children

Doctors treat fingertip amputations somewhat differently in children younger than
6 years of age. After thoroughly cleaning and preparing an amputated fingertip, the
surgeon may reattach it to the finger. The fingertip may continue to grow relatively
normally, even if bone was exposed. This is especially possible in children younger
than 2 years of age.

Complications

In many cases, surgery can return a large degree of feeling and function to a fingertip
injury. However, there are complications associated with the injury itself and with
surgery for fingertip injuries. Your doctor will discuss each of the risks with you
and will take specific measures to help avoid potential complications.

Recovery from a fingertip injury may take several months. After your injury heals,
mild to severe pain and sensitivity to cold may continue for up to a year or may even
be permanent.

Your doctor or a hand therapist may recommend specific exercises to improve range
of motion and strengthen your hand and fingers. They may also suggest additional therapies
to help promote healing and function. These therapies may include:

AAOS does not endorse any treatments, procedures, products, or physicians referenced
herein. This information is provided as an educational service and is not intended
to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance
should consult his or her orthopaedic surgeon, or locate one in your area through
the AAOS "Find an Orthopaedist" program on this website.